Finding Better Solutions to End Bullying—What a Midwife Can Doby Marinah Valenzuela Farrell

This fourth article in our series on bullying explains what midwives can do when they find themselves targeted by a bully. The last article, in our next issue, will cover what organizations can do to end bullying.

“Effective anti-bullying strategies must be developed and introduced as a matter of urgency and their use carefully evaluated. At the same time, awareness of the prevalence and consequences of horizontal violence must be raised.”
—“Why do Midwives Leave?” a report jointly written by the Royal College of Midwives(1)

“Dignity is a useless concept in medical ethics and can be eliminated without any loss of content.”
—Editorial, British Journal of Medicine(2)

Many health care professionals now quite commonly participate in and are the recipients of bullying behavior. This has become the norm in our culture and is seen as a way of creating stronger individuals who produce better economic results through the use of power and intimidation of others. Many individuals deal with this on a daily basis and cope as best as they can in an environment of harassment.

However, a great number of individuals encounter situations that they recognize as being not only hostile and violent by their very nature, but the cause of their depression and trauma-induced illnesses. These individuals often are not supported in our work culture; frequently they were targeted because their diligence and dedication to hard work and innovation stirred up the ineffectual and low-performing bully. More and more studies are becoming available in the US on bullying in schools; and Europe has been a leader in looking at the effects of bullying in the workplace, as well as in initiating legislative reforms to address this situation. A recent magazine article stated that more than 44% of workers in the US feel bullied, with 64% feeling that legal action should be an option.(3)

This article will look at how individuals who are being bullied (“targets”) can proceed. Once the target comes to terms with the fact that she is being bullied, she must determine how to proceed.

Upon realizing that she is being bullied, the most important thing a midwife who has become a target must do is create a plan of action. She must document everything that occurs, keeping all professional communications that may be hostile and keeping impeccable records regarding events and incidents. She must note dates, times and any witnesses who were present. Generally, bullying situations encompass many “little” acts of hostility, so once a target decides to take action, all of these should be noted in order to prove the behavior. Although co-workers or other midwives often will look the other way during a hostile attack, if they are listed as witnesses, these peers may be a valuable resource (especially if a claim is litigated, in which case they would be under oath).

In addition to developing an action plan, a target must immediately speak out against the bully even though she may find doing so painful and she also may seem to be the “disruptive” one, appearing to validate the bullying claims. Staying quiet is a mistake, although speaking out can become especially difficult, as the target often loses confidence and feels embarrassed or ashamed. Many targets feel less professional if they have to address the behavior or seek help—however, this step is crucial. The more attention a target can draw to a bully’s behavior, the less chance that she will become isolated—a goal of any bully. All victimized individuals feel a sense of shame with unwanted negative attention; however, making things uncomfortable for the bully(ies) by speaking the truth about a situation or addressing the behavior publicly is better than letting them create their own version of the truth.

Recognizing and addressing the behavior immediately will make the bully aware from the outset that such behavior will not be tolerated. Mistakenly, targets often believe that management or leaders of the organization will recognize and stop certain behavior, but this usually is not the case. Peers look the other way during bad behavior because they do not want to be involved or out of misguided fear and/or suppressed aggression, so that bullying continues until early intervention is not possible. The target must be the one to take action and address the problem from the outset, even if the organization has clearly defined policies against bullying or the bullying is in conjunction with other legally definable harassment or discrimination.

Once the target has identified bullying behavior, maintained careful records and spoken out about it, she will need to find help to deal with it. This can be in the form of outside help such as a bullying hotline (available in Europe but open to anyone) or a professional counselor either within or outside the organization. A target also may wish to consider seeing a health professional to deal with any stress-related illness (an organization may not have a written anti-bullying policy, but the health and welfare of employees are protected by various laws). She also should consider starting preventive health care visits, eating well and exercising to eliminate some of the stress.

The target then must decide whether to take action against the bully or to leave the profession/organization. An important consideration is that without an organization’s support or the support of the higher-ups in the profession, breaking the cycle can be very difficult—not impossible, but extremely difficult. Leaving is well within reason for a target whose health is failing or in cases where the bully is supported by peers in such a manner that the behavior is likely to continue. In that case, the person’s health may be more important than trying to fight the system. If she chooses this route, the target must realize that she did not “lose” by leaving; if anything, the organization or profession lost.

A target who does choose to leave an organization should not do so quietly. Instead, she should submit formal letters and written complaints as well as outlining her reasons for leaving. A target also may want to consider litigation or mediation with the organization to bring the situation to light. Unfortunately, bullying experts agree that mediation does not work with a bully or an organization that supports bullying. Yet mediation attempts that are well-documented are taken seriously if the target decides to pursue more formal charges and can be a comfortable first step for a target who feels hesitant to jump into litigation.

A target who decides to stay with an organization that has no clearly defined policies should begin with an informal complaint process—meeting with leaders and keeping notes. If no changes occur, she may want to enlist the help of outside litigators against the organization and/or against the bully him- or herself. If the informal process does not work then the only recourse for a target who wants to remain in her profession is litigation.

Isolated or solo-practicing targets may have a harder time dealing with bullying. Individuals who are not in a formal institution or association of professional peers often do not have a way to seek redress; many homebirth midwives fall into this category. Homebirth midwives often do not belong to an official organization and often bear the brunt of bullying from other health care professionals. What can a homebirth midwife do?

I spoke with Dr. Gary Namie of the Workplace Bullying Institute about this issue in a recent interview. His response was:

“You have to get the member-on-member stuff under control or you will destroy the profession. Ones-y, twos-y meetings to get bullying under control just does not work. On one hand [midwives will] talk about solidarity in the way they fight against other professions that want to end midwifery—the external gorilla. But, on the other hand, if you don’t take care of the internal (your personal side) then what the profession has done is phased out too many of the good people—the best representatives of midwives—because that is who is going to leave.

“A good reason to stop hurting each other, and the most important, is for the long-term survival of the profession. The internal battles will wipe out the new generation. If the old ones [midwives] drive the new ones to the ground, the new ones will say it isn’t worth it. The internal battles will define the quality of their work life and their commitment. That is how important bullying is.

“For nurses in hospitals it is bad enough. This is very evident when we speak to nurses’ groups, but I think midwifery is more vulnerable. There are a lot of groups that don’t want anything to do with [midwives]. So, make this an internal issue and the profession must clean house. It is also a women’s issue because most of bullying is woman on woman. You [midwives] need one generation to say ‘This is our new model,’ or it won’t change. Who is going to make the first step? You don’t mediate violence.

“If the profession has stronger policing then you can make a statement to drum out the few that have always had it their way. Most of them would leave. If the effort becomes too great to bully, the bully won’t do it. They leave. And it would end the game and it would be better off for everyone. The top of the profession needs to do this with a vision for the next generation of leaders. If you fall in line with the old model you may just self destruct.”

A solo midwife should begin by creating a circle of support around her. She should consider holding a meeting (hopefully with at least two other midwives) to discuss the situation and how best to handle the bullying occurring in the community. The midwife will be faced with varying options, depending on the status of the bully, but she has to understand that she must actively oppose the bully’s path or somehow remove herself from the abuse.

Again, a crucial step is to document everything regardless of who the bully is and regardless of what she plans to do. Although a lone midwife does not have a lot of power, documented evidence is very strong if ever needed.

Enlisting professional help is also a key component. For example, contacting a local Waldorf school or another school that offers bullying seminars or training can be a wonderful way to gain a better understanding and obtain the support of those who deal with bullying in schools (workplace bullying is not much different). I have been amazed at the response I have had by simply calling counselors at schools that provide training in dealing with schoolyard bullies. They can relate to adult bullying and also can offer supportive information to adults looking for resources and organizations looking for speakers. This is an inexpensive solution to finding someone to talk to or help with individual bullying.

Midwives who have no other recourse can also try mediation or legal action and should immediately begin a program of stress reduction and health. Remember, people who are alone, isolated and being bullied put their health on the line! If a midwife has no other choice, then her best bet may be to completely avoid the bully until such a time as she can initiate some recourse. Although this solution will not feel like the strongest or give her a feeling of justice, it is the solution that will protect the midwife from becoming ill and unable to do her job.

Certainly, solo midwives have a much more difficult task because of the complexity of dealing with violence that is outside of an institution yet still within the sphere of professional life. Tackling bullying is a lesson in societal peacemaking; many other communities have written statements against community bullying and harassment. These statements can be used consensually among even small groups of midwives to elicit change in their community with an understanding that what happens locally can affect change globally.

Individual targets need to recognize and deal with a bully immediately, note every incident and make a determination as to whether they will stay in the hostile environment and address the situation or leave. All individuals need to look to local politics and support passage of laws that protect the targets of bullies, whether they are children on the schoolyard or adults in the workplace (or anywhere).

Most importantly, the target needs to be aware of the health effects bullying and violence can have on her quality of life.

In a culture of bullying all of us must speak out about the abuse, ask for help without feeling shame, change the current violent work culture to create a better one and, as midwives, end any chance that horizontal violence will endanger this immensely beautiful profession.

Through networking and education, Midwifery Today's mission is to return midwifery care to its rightful position in the family, to make midwifery care the norm throughout the world, and to redefine midwifery as a vital partnership with women.